“Dr. Julie Gerberding, director of the federal Centers for Disease Control and Prevention, noted that the United States invests more on health care than any country, but that its health care system ranks 37th.” – Denver Post, April 29 2008

A Google search reveals that many people quote this World Health Organization figure on Denver Post blogs. But do any of them know what the rankings mean? John Stossel dissects the criteria:

In the WHO rankings, the United States finished 37th, behind nations like Morocco, Cyprus and Costa Rica. Finishing first and second were France and Italy. Michael Moore makes much of this in his movie “Sicko.” …

But there’s less to these studies than meets the eye. They measure something other than quality of medical care. So saying that the U.S. finished behind those other countries is misleading. …

The WHO judged a country’s quality of health on life expectancy. But that’s a lousy measure of a health-care system. Many things that cause premature death have nothing do with medical care. We have far more fatal transportation accidents than other countries. That’s not a health-care problem. …

When you adjust for these “fatal injury” rates, U.S. life expectancy is actually higher than in nearly every other industrialized nation.

Diet and lack of exercise also bring down average life expectancy.

Another reason the U.S. didn’t score high in the WHO rankings is that we are less socialistic than other nations. What has that got to do with the quality of health care? For the authors of the study, it’s crucial. The WHO judged countries not on the absolute quality of health care, but on how “fairly” health care of any quality is “distributed.” The problem here is obvious. By that criterion, a country with high-quality care overall but “unequal distribution” would rank below a country with lower quality care but equal distribution.

Other good critiques of the WHO study include Glen Whitman, who blogs about it here and published a summary here, which also links a more detailed Cato policy analysis here.

Just one comment….
Are you talking about healthcare, insurance or the health of Americans? It seems you are talking about healthcare but meaning helath insurance. Everyone has health care available in the U.S. There are 46 million people without health INSURANCE, in most cases by their choice.
Just a thought, you ned to distinguish better wat part of this crazy system you are referring to.

‘I don’t want to pay from someone elses insurance.’ What exactly do you think insurance is? Its a pooling of risks to soften the financial blow resultant from a House Fire, Health Incident or Car Accident.

There’s difference between voluntary risk pooling and being forced to either (1) Pay for someone else’s premiums, or (2) Be forced to pay higher premiums because it’s illegal to pay lower ones, or (3) be forced to pay higher premiums because the affordable plan you want is declared illegal by politicians.

Brian writes: “If I agree with you, can I get a cut of whatever payouts you’re recieving from the health industry?”

This is just pathetic. First of all, it’s a personal attack and avoids the issues. Second, I’ve written at length about how current tax policy and other political controls shield insurers from competition and punish people for buying medical care directly, rather than through insurance. For example, here:

Lastly, the insurance lobby (AHIP) supports the mandatory insurance scheme promoted by many politicians in Congress. Why wouldn’t the insurance industry love “reform”? It forces people to buy their products, and makes affordable insurance illegal, so we’re forced to by pricey policies? In case you have not noticed, I oppose this.

“Pinko” wrote: “Brian: Poppet had some very good points. I see you replied to many of the comments but seem to have skipped over that one, which basically shot down (crash and burn) one of the primary arguments in your blog”:

At risk of repeating myself, a free-market for health care and insurance leaves people free to form and join various types of organizations. If someone wants to start a co-op or company something called “Canadian-style health care” or something, then people are free to join.

Brian, I would like to address a percieve flaw with your logic and the commentors saying ‘I don’t want to pay from someone elses insurance.’ What exactly do you think insurance is? Its a pooling of risks to soften the financial blow resultant from a House Fire, Health Incident or Car Accident. You don’t want to pay for other people’s health care, but you don’t mind paying to have the bumper on their Civic buffed out or their home rebuilt after a fire?

In addition, the notion that a free market will do better is assuming health care companies operate with a moral compass. The GOP baby step to free market would be the notion we should let these companies sell accross state lines. As the credit card industry proved so clearly, this would make things worse. Credit Card companies immediately moved their corporate head quarters to the states with the least regulation. They essentially held a carrot of moving shop to the states whoses senates passed laws which benefited their companies versee the consumer. This resulted in competition between states to see who could screw the consumer the most, and they would set up shop there and be able to operate within that states legal guidelines throughout the entire country.

I work 50-60 hours a week. I have a wife and two children. I’ve paid taxes every year, on time for over 25 years. I own my own business, and I thought small business were the back bone of America, yet I can’t afford insurance for my family. The cost to insure my family with the equivalent plan I had as a sales associate wearing a name badge and selling cellphones at a mall would be about 1000 a month or 20% of my income. I actually paid it becaue I thought it was important. Of the medical bills I incurred during that year I had to pay an additional 5,000, of which only 20% was covered. Which mean I paid 16,000 for my insurance and I had not major medical issues. I went to the hospital once for my a pulled muscle in my back. Despite having insurance, I still had to pay 1000 on a 1400 bill. I couldn’t afford it and had to cancel it.

Corporation have become an amoral cancer which will justify anything as long as its legal and will make them money. Why is it every other industrialized nation in the world has better quality health care for cheaper (and we still don’t cover everyone), it costs them less and it covers all of their citizens?

The true problem is this simple fact. There is a segment of this population, you included, which believe health care is a privelage, not a right. Until we as a nation can come to understand it is every American’s right to affordable health care, this problem will never get solved. I don’t want free health care, I just want to know I won’t be dropped when someone in my family truly does get sick cause I didn’t report a wart removal in 8th grade. I want to pay a monthly fee and not have to worry about how much more I have to spend to make sure my children are covered. I want what every other industrialized nation in the world has because they don’t have free market, they cover all their citizens and they on average, pay half of what we do.

If I agree with you, can I get a cut of whatever payouts you’re recieving from the health industry? Hell, I’ll do it if they give a plan that actually covers my family and I can afford.

Brian: Poppet had some very good points. I see you replied to many of the comments but seem to have skipped over that one, which basically shot down (crash and burn) one of the primary arguments in your blog.

It would be of great help if you can point to a statement in this blog post this is not true.

Why do you think that I am “you are working hand in hand with the health care industry”? On this blog I have posted many times about how they benefit from legislation that shields insurance companies from competition.

You are spreading more misinformation. My father went to Canada to have a new type of surgery done that was not being done in Michigan at the time. My grand daughter is Canadian, and when my daughter gave birth to her she had several weeks of leave time from work to be with my new grand daughter. A nurse also came to the house every week to check on my grand daughters progress. My cousins in Norway pay less in taxes then I do, and have free health care and education through the college level.
The problem with you spreading more misinformation, is that you are working hand in hand with the health care industry that is spending millions of dollars a day to prevent any changes to their billion dollar cash cow.

Abraham Lincoln said, “Democracy is the government of the people, by the people, for the people” Americans pay more for heathcare and get less access to affordable care than most industrialized democratic countires, yet are number one in military spending. Why does the party of Lincoln believe it is not okay to aquire much of what the free world gives to their citizens? I’ve talked to many Canadians, and have been told that they are happy with their care, and not to believe our politicians. Every lawmaker against health reform has access to affordable insurance paid by our tax dollars. As in education, the quality of health for every American affects us all.

“A government big enough to give you everything you want, is big enough to take away everything you have” Go ahead and preach, that everyone should have health-care, sounds great in theory. All of the same people will be complaining when the government starts telling them what they can and can’t eat. The funny thing is most believe that the wealthy will pick up the tab “wrong”. Anytime we have raised taxes on the rich they raise their prices to cover the cost, or their employees get paid less. Understand our founding fathers studied 6000 years of recorded history, and figured out that all empires and kingdoms eventually failed. They failed because of concentration of power, so they decided to learn from their mistakes. That’s why our founding fathers said our country will be run by the many, not the few. This is separation of power, and this separation of power is slowly withering away. Every time we have a crisis we want the government to save us, and end up with more government control. What happened to self responsibility, hard work, and dedication? Instead we now look for the easy way out, and the result is what you see now. More government control and like I said, you all want it until it infringes on one of your luxuries, you want everything handed to you and don’t want to give up anything to get it. I have no problem with helping someone in need I have a problem with the government making me, that is not freedom of anything. If you notice there is a trend, it is entitlement issues. I should have this job because I’m _____ you fill in the blank. Seriously people stop playing on the emotional heart strings of people, “Oh you would let a baby die”, nobody said that. Some of us want only what we deserve and have some pride. I have an idea let’s look at the source of health-care cost rising ummmmm yea government involvement. If you removed government and insurance companies that would be reform. Did you know that long ago working for the federal government was a part time job? Government officials use to all have full time jobs along with there congressional duties. That’s because they were meant to have little to do with our lives. Another question have you seen the commercial about raising taxes on energy? The people are so sad and say “now is not the time to raise our taxes on energy”.. Perfect example, the same people want free health-care. Raising taxes on them and infringing on there TV time is bad, but believe that raising taxes for health-care is great. How about you stop watching TV, get a job, exercise, and you won’t need me to take care of you.
One more question, I keep hearing about 47 million Americans don’t have health-care. My question is how many chose not to have it, and how many are ILLEGAL ALIENS?

I don’t want to pay for other’s healthcare either. Why should I have to pay for other sick people? I also don’t think I should have to pay for public schools. I don’t have children, why should I have to pay for other people’s children? This is very socialist. Another thing – police. I have several guns, I dare anyone to try and rob me. I don’t need police. I should not have to pay for this. Another thing – roads. Why should I have to pay for roads that I don’t use? I work in my own basement and don’t need roads. It is wrong to make me pay for roads and highways. Another thing – the fire department. Again, very socialistic. I’ve taken volunteer fire fighting training classes and feel very compitent to handle any fires that might arise on my property. Another thing – national defence. Half of the federal budget goes to defence. This is outragious. Socialism OUT OF CONTROL. Let me keep my tax dollars and I’ll provide for my own defence. I’ll colaborate with my neighbors. Communities should look after themselves. Small groups of armed citizens worked in the revolutionary war and worked in Afganistan against the Russians. SOCIALISM IS RAMPANT IN THIS COUNTRY. CITIZENS BEWARE!!

Wow, Bunker Man, sounds like you don’t need anyone, why don’t you move to your own island so you won’t have to pay for anyone. Roads – you may not use them, but if you get sick & need an ambulence or a ride to the doctor, & they can’t get to you because the road is in such bad shape, then you will wish you would have paid for the roads. Police – Proctect everyone not just you, where you shop, protected by the police, proctection from personal robbery is low in the main scheme of things for police, unless you want murders, rapists & other such runnig rampet. Fire Dept -trainig classes are good, but can you honestly know how you will react in a situation where a fire can quickly get out of control. National Defence – sure let’s get rid of the military their not needed, small groups of people with shot guns can easily repel armies with tanks, planes, warships, & helicopters, the revelutionalry war was a long time ago, if you think you can fend off a tank with a shot gun, go ahead & try. Schools – if you don’t pay for schools even if you don’t have kids, you end up with a country full of idiots like yourself who think they are the greatest in the world & don’t need help from anyone. By the way, smaill groups in Afghanistan did not defeat the Russians, yest they were an inconvience, but did not defeat them, Russians defeated themselves by spending too much & extending themselves too far, money & public opinion not small groups of fighters is why Russia left that country.

Brian replies: Hmm. I don’t think this tone or attitude is very conducive to civil discourse.

If it were possible to fund roads by charging only those who use them, would you be against that? For example, toll roads? Or even a tax on gas, though it’s not as targeted, and gas taxes tend to get lost in general funds.

Is there anything government should not force people to fund for the sake of others? Shoes? Haircuts? Internet access? Is anything outside the scope of the proper role of government? If so, why?

Having great health care for the majority of Americans is a good thing. Having none for others is a disaster.

Baseball metaphors make life make sense.

The health care system in the United States is like having a team of seven great baseball players, but no shortstop or first baseman. It doesn’t matter how good the others are. You’ve got gaps in your defense. It’s terrible management, and you’re going to lose.

Are we morally ready to let people die at the doors of our hospitals because they don’t have health insurance? Only if you answer “yes”, can you argue in favor of a free market health insurance.

However, I’m guessing that the vast majority of Americans will answer “no”.

If we are not ready to let them die, then we are agreeing, as a society, to pay for the medical care for such individuals. In fact, that is what we’re doing today, except that we’re managing its costs very poorly. If an uninsured person shows up sick at a hospital, they will get treated, and those costs are paid by the other patients who happen to have insurance. That’s a terrible way to handle that. We could do the same thing, but manage it properly.

So, we either let people die at the door of the hospital, or we agree to pay for everyone. I’ll take the latter option. But let’s do it right.

Brian replies:

Juan, is the concept or reality of voluntary charity inconceivable to you? For you, it’s either “we let them die” or “we are agreeing, as a society, to pay for the medical care for such individuals.” “We” denotes a collective action where everyone does the same thing. How about individuals taking responsibility for what they want in the world, e.g., buy donating to or running a charity to address problems that they want addressed? Government isn’t about, or should not be about, forcing others to donate to causes that you think are important.

“Let’s do it right.” Who decides what’s right? With voluntary charity, you can donate to the charity (or start one yourself) that does things “right”, as you see it. But it’s never right to force someone else to donate to charity.

I don’t want to pay for other’s healthcare either. Why should I have to pay for other sick people? I also don’t think I should have to pay for public schools. I don’t have children, why should I have to pay for other people’s children? This is very socialist. Another thing – police. I have several guns, I dare anyone to try and rob me. I don’t need police. I should not have to pay for this. Another thing – roads. Why should I have to pay for roads that I don’t use? I work in my own basement and don’t need roads. It is wrong to make me pay for roads and highways. Another thing – the fire department. Again, very socialistic. I’ve taken volunteer fire fighting training classes and feel very compitent to handle any fires that might arise on my property. Another thing – national defence. Half of the federal budget goes to defence. This is outragious. Socialism OUT OF CONTROL. Let me keep my tax dollars and I’ll provide for my own defence. I’ll colaborate with my neighbors. Communities should look after themselves. Small groups of armed citizens worked in the revolutionary war and worked in Afganistan against the Russians. SOCIALISM IS RAMPANT IN THIS COUNTRY. CITIZENS BEWARE!!

” If you correct for two causes of death not directly related to health care—homicides and automobile accidents — the U.S. actually rises to the top of the list for life expectancy”

I’ve been looking into this (and responded in detail over on Mondo’s board), but this seems not to be the case. For factoring out these causes to have this effect, both would have to occur in statistically significant numbers and would have to occur at higher rates here than in other countries. These conditions don’t seem to be fulfilled.

We do have a higher homicide rate than many other nations (particularly industrialized ones). However, this cause represents only 0.8% of our annual deaths (in 2006, according to the CDC). The resultant effect on the statistical average is thus low.

It’s a different story for traffic fatalities. They are more statistically significant (accidents of all types represent about 5% of deaths per annum) and are once again skewed somewhat lower in the age range. However, the US actually has a relatively low rate of traffic fatalities per unit of population. For example, while we have 13 times the number of traffic deaths as the UK, we have 40 times the population. Interestingly, the developing world, where I expected lower figured (fewer cars per capita), actually has very high rates of traffic deaths per capita (WHO Traffic Report).

So basically, if you factor out these causes of death for all countries (a somewhat dubious evaluative action, in any case), the US actually loses ground against the majority of nations.

On a more obvious note. Where does your money go when you pay into insurance and never get sick or rarely receive care? Two places: to pay for SOMEONE else’s coverage or to line the insurance company’s pockets. Either way you look at it, you or your employer doles out money to pay other people’s bills. That’s the nature of insurance in general. Insurance companies are in the business of risk analysis and risk management to reach bottom-line targets. They don’t care about your health.

You would think that people who how have a “bias is for free markets“ would look up what a free market is. An oligopoly is not a free market. A free market requires a large number of buyers and sellers and that the participants have knowledge about the market (what is sold at what price). An oligopoly produces an oligopoly market with very different results than a free market.

Brian is correct in that we have not tried a “Market approach”. In a free market system: if a baby needs $10 of medicine to live, and the baby doesn’t have $10; then the baby dies. If you think that we should “use your money and mine to pay for” the baby’s medicine, then you are an anti-free market pinko socialist.

Currently the government pays for about 47% of health care. Brian needs to explain to all those Medicare and Medicaid welfare queens that they need to stop sucking on the tit of big government.

And a free market will never be possible until we repeal EMTALA. Oracle Brian, can you see any moral, political, economic, or practical problems with that?

I would like to make few points about so called “socialized” health care system:

In the US, only two or three insurance companies control more than 75% of the private health insurance. The logic of insurance policy in itself is also a “socialized” system. Why ? No one pays the actual cost whether car insurance or health insurance. The risk is spread to other people the same way tax-payer funded health care system. Stop arguing about “Socialized” system.

Brian replies:
There is a difference between socialism and insurance. Under socialism or socialist policies, government forces one person to pay for goods and/or services that another person consumes. Insurance is, or at least can be, a product that people choose to buy. The difference is about coercion vs. liberty.

I would just like to make a couple of simple statements to begin and then answer a few comments made here.

1. The U.S. has the most expensive health care system in the world, at least twice that of most industrialized nations.
2. You would think that, as a nation, we would be the healthiest country in the world at those prices. Whether you accept the W.H.O. rankings or not, by most accounts, U.S. health care is far from the top. Can we say that this might imply that we are getting ripped off in current health care system?
3. More than 60% of U.S. bankruptcies are health related. If the cost of the U.S. health care system continues to escalate as it has over the past few years, it will bankrupt the country.
4. There are 48 million people who have no healthcare in the U.S. This is a moral/ethical travesty. From my perspective, it is imperative to make sure every American has adequate health care and I believe it should be a moral priority.
5. We are told that we have “freedom” within the U.S. health care system, but we don’t. Insurance companies tell us what care we can or cannot receive and which doctors we can go to and which drugs they will let us have. We don’t have choice except to choose a different Insurance company to tell us what we can and cannot do.
6. Insuance companies are not in the business of “health care.” They are in the business of making money. They will deny any coverage they possible can short of a lawsuit to increase their bottom line. They are not interested in your or my health.
7. Paperwork cost for doctors and hospitals to deal with all the different health insurance companies is estimated at over 200 million dollars a year. This is clerical waste that we all pay for.

One asks, “Is it right to force one person to pay for another’s medical care?” Well, if someone goes to a hospital or emergency room for catastrophic care, and they don’t have “health insurance,” they will be treated and whether they survive or not, the cost of their treatment is passed on to you via higher hospital costs for paying customers and higher health premiums on your health insurance. I might add that many who have insufficient health coverage will wait to see a doctor until medical problems are advanced or catastrophic. When people have full health care coverage they tend to get consistent preventative care thus limiting the catastrophic health problems which elevate the cost to the health system.

Who would want to “prohibit free and voluntary exchange of medical goods, services…”? Don’t we want to fix what is wrong in order to promote better delivery of goods and services to the greatest number of people, if not all the people? I thought that is what health reform is all about.

Without going into detail of an already too long comment, these are the reforms I would favor:
A. make health care available to all U.S. citizens (no exceptions – everyone)
B. eliminate waste in the health system (many ways this can be done)
C. create legal reform (regarding malpractice lawsuits)
D. make sure all decisions regarding health care, including choice of doctor, hospital, drugs, etc… are exclusive to doctor and patient (not in the hands of insurance companies or government)

Sorry for being long winded but I believe health care reform is necesssary to save the nation from eventual economic and ethical disaster.

The bottom line is that people shouldn’t be turned away from getting the care they need. The system, in that regard, is horrible. Families WITH insurance go into debt once a member is hit with a serious illness. 50 percent of all bankruptcy filings are partly the result of medical expenses. Every 30 seconds in the US someone files for bankruptcy in the aftermath of a serious health problem.
Anybody who says this is a fair system is not empathetic. Any one of us is one illness away from having our savings (if we have any) wiped out because of ridiculous out of pocket expenses and denial of service.
Families should not have to deal with that pressure when they are unlucky enough to be the victim of a terrible illness.

Living in San Diego, California I can tell you a significant number of the residents in So Cal are going to Tijuana for their dental, medical and pharmaceutical needs and guess what, not many Mexicans are coming into the US for the care, unless they are very wealthy and insured. So much for the ‘they are coming to America for healthcare’ argument.
We’ve tried the market approach, and it has failed, maybe its time to try the socialistic approach. Oh and Brian, do you have health insurance? If so you are a poor arbiter of whether we should have a system or not. Ask someone who doesn’t and lets have them publish their issues and the failings of the ‘system’ in this blog. Seems like we only hear from the folks that have the broadcast facility to tell their side of the issue.

Anyway, if you are concerned about the uninsured, and do not mind government-run charity, why not push for tax-funded vouchers for insurance? What do you think of food stamps? They are vouchers for food redeemable in a relatively free market for food. Should the program be replaced with government-run grocery stores?

I keep hearing about all those “foreigners” who come to the US for health care. YES we have excellent doctors and facilities. Unfortunately “the best healthcare in the world” is only the best for those who can afford to buy it – whether they come from the US or elsewhere. Also ACCESS to that “best” healthcare is an issue – do you live near one of these “best” doctors and facilities? Does your insurance company ALLOW you to access these doctors and facilities? Will your insurance company decline the procedure etc. in this “best” system? Or worse yet, will your insurance company drop you when you actually use or attempt to use your coverage? Insurance companies have entire departments whose goal is to deny care (did you forget to tell them you had acne treatments, or had a yeast infection at some time past – actual situations which resulted in these individuals being dropped) Those who work in these departments are rated on how much they “save” i.e. don’t spend on health care claims.

X amunt of $ is paid in premiums. Those $ are presently spent on administration (3-4% for Medicare, 13-14% for private insurers) including administering exhorbatant bonuses, paying for advertising, image enhancing offices, logos, public relations,etc.

What’s left is available for health care and profit and those billions of dollars that go to CEO’s such as Patric Son-shiong-APP Pharmasudicals.

The impetus is not toward distributing premiums to cover health costs, rather to fullfil the profit motive of these corporations. We have a health care MARKET PLACE not a HELALTHTCARE SYSTEM.

Yes, “we” have a health care market place. But it’s not a free market, as it should be, as this would respect people’s rights to trade with each other on a voluntary basis. I do not want a health care “system,” as this implies that government forces us all into it. As I have written, having a health care “system” is the problem.

Tao means he would like to use your money and mine to pay for his medical its cheaper that way and since we’re such a bad country when it comes to health why does everyone keep coming here to get it . Even members of the canadian parliament when they have such good health care. Tao needs to see how WHO gets its findings if the US had mediocre health care for all we would be probably #1 . Mediocre is the key word here, but since only 250 million have real good healthcare and 46 or so million dont we are 37 strange huh. there are other areas which are even worse because of the way WHO gets its #

conservativism never fails, it’s only betrayed by “conservatives”. that’s the message we get whenever we’re confronted with failures brought on by ideologically-based (e.g. “free markets, …”) thinking and acting. we’re now hearing the same thing with regards to health care reform: all we need now is “real competition”.

what we need now, as always, is to be able to respond freely to the needs of the moment without fear of betraying life-less ideological “truths”. we need to progress, not conserve, our way out of this problem.

Brian replies: I cannot say that I get what “taochiapet” is saying here.

All statistics are misleading in one way or another; however, it is an error to dismiss WHO’s finding, because it does not support your bias. The U.S. has the highest health care cost in the world and does not cover all of its working citizens. That is a fact and in and of itself cries for reform especially since the costs keep increasing at a rate greater than inflation. Second, there are not statistics, which show that the U.S. has the best health care system despite being the most expensive. This is another condemnation. Third, there is no competition in the industry. Doctors, hospitals, and drug companies set the price they want. Medicare, medicaid, and insurance companies pay. Yes, there is some push back, but there is no market price. Last, the industry is rife with unetithical and often fraudulent billing practices. People who argue against reform in the light of all bad facts and discontent are just “turf protecting”.

My bias is for free markets, individual liberty, voluntary relationships, and individual rights. The market for medical care and insurance in the U.S. is far from free.